Healthcare Provider Details

I. General information

NPI: 1538283148
Provider Name (Legal Business Name): ELISA M. SANTOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5009
US

IV. Provider business mailing address

240 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5009
US

V. Phone/Fax

Practice location:
  • Phone: 631-726-8200
  • Fax: 631-726-8886
Mailing address:
  • Phone: 631-726-8300
  • Fax: 631-726-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number243020-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number243020
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: